Risk Adjustment Actuary

Clover is reinventing health insurance by working to keep people healthier.

We don't just provide health insurance—we deliver the kind of healthcare that people deserve. The Revenue Analytics team at Clover is made up of collaborative and strategic thinkers who are excited about the impact technology can have on healthcare. In this role, you will partner and help support a core area of responsibility for our Revenue Analytics team.

We're looking for a tech-savvy actuary interested in enhancing Clover’s ability to make smart, data driven business decisions to join our team. In this role, you will support Clover’s risk adjustment function.

As a Risk Adjustment Actuary, you will:

• Support the monthly close process, including the development of actuarial risk adjusted revenue accruals and analysis of results.
• Maintain internal CMS HCC and RxHCC models for calculating member level risk scores.
• Build reports to track ROI on various risk adjustment initiatives.
• Support actuarial teams in the development of risk scores for forecast and bidding purposes.
• Provide analytical support in the optimization of risk adjustment related activities while maintaining compliance with CMS standards.
• Support the claim and supplemental submission workflow for CMS EDS submissions.
• Develop data pipeline tracking reports and analyze, research, and resolve encounter submissions.
• Manage the end to end flow of data submissions to vendors and government agencies to mitigate data leakage and submission errors.
• Collaborate with internal departments, including but not limited to, Data Science, Finance, Actuarial, Operations, Provider Network Management, Engineering, and external vendors on risk adjustment activities.
• Be eligible to participate in Clover's Actuarial Student Program.

You will love this job if:

• You are passionate about your career and are excited to demonstrate your value in a highly collaborative and cross-functional environment.
• You dream about ways to make the healthcare system more efficient and are excited about the prospect of leveraging modern tools and techniques to do so.
• You are analytical and strategic and love working in a collaborative, transparent work environment.
• You want to make an impact. From project scope to priority to implementation, you'll have an impact on how decisions get made.

You should get in touch if:

• You have two years experience with Medicare Risk Adjustment, CMS EDS submissions, and healthcare claims data.
• You have at least two years of programming experience. Examples include SQL, R, Python, SAS, VBA.
• You have completed three or more actuarial exams.
• You have an interest in building automated tools around actuarial analysis and experience building analytic dashboards.
• You are a self-starter, have a high degree of internal drive and motivation, and desire to execute at a high level.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

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About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.